Like Dr Terry, we believe that preventive ethics approaches can mitigate ethical problems that occur “downstream” once patients are in the intensive care unit. However, we suggest slightly different approaches than he. First, in keeping with what we discussed previously, we think the question should not be, as he suggests, “Would you want us to ignore your living will if your loved one disagrees with it?” and instead should be, “Would you prefer your advance directives to be strictly followed or serve as general guidelines?” Second, we think patients’ “narratives” should supplement and be attached to patients’ ADs. These are responses to questions about the burdens the person is trying to avoid, what is important to them, and at what threshold they would consider continued aggressive measures to be unacceptable. Ultimately, we would like to shift the emphasis of ADs away from treatment modalities and more toward patients’ stories and specific burdens they are trying to avoid. This should allow for making decisions that are congruent with patients’ preferences.